Healthcare Provider Details

I. General information

NPI: 1275021230
Provider Name (Legal Business Name): AMIT KUMAR AGARWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W TOWN PL STE 109
ST AUGUSTINE FL
32092-3648
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-7205
  • Fax:
Mailing address:
  • Phone: 904-398-7205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME166874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: